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ADHD and Executive Dysfunction: What is it, Why it happens, And How to Deal With It?

Julia Ovcharenko, CEO of Numo
January 12, 2024

When talking about ADHD, you can’t bring up executive dysfunction, aka executive function deficit

Brrrrr

Sounds scary and complicated. 

But what is living with ADHD if not dealing with scary and complicated things your brain does all the time? Am I right? 

Well, simple. Here, at N U M O, we are all about meditating on all things ADHD and giving them back to you in an easy-to-digest way! 

Thus, let’s dig into today’s read as we unravel all the bits and bobs, such as:

  • What is executive function?
  • What is executive dysfunction? 
  • How ADHD makes (not) functioning so much more exciting.
  • The ways you can get help are easy.

Aighty-tighty. Call me Minecraft Steve ‘cause we are digging in

[What are executive functions?] What are executive functions? 

To wrap our heads around executive dysfunctions, we first need to unwrap what executive functions are. 

Unlike many other automatic behaviors we perform without a thought, executive functions demand our awareness and purposeful effort.

Executive functions are mental processes and skills we use to achieve our goals, partake in social interactions, and learn and adapt to our ever-changing world. (1) They're the crucial things that keep our daily lives and personal independence in check. 

It sounds like trigonometry when you say it scientifically. But it’s just a fancy way of describing all the things you do be doing on the regular. To prove it, let’s look at some executive functions to get a clear picture.

Working Memory

For a start, we can delve into the intricacies of working memory - an essential function that allows us to “store” small bits of information in a readily accessible form. (2) It’s a bit different from short-term memory, as working memory also includes the active manipulation of the information, not only its storage. 

Working memory can be nonverbal and verbal. Our verbal working memory keeps us in the loop when we're soaking in auditory information. Thanks to verbal working memory, we can memorize instructions and comprehend the meaning of things people tell us…or at least pretend hard that we do. 

Meanwhile, non-verbal working memory activates when we’re visualizing something or remembering the patterns or the location of something in space. It also kicks in when we’re doing calculations and even just reading - so we don’t get lost in the paragraph we navigate.

These two pillars of working memory seamlessly collaborate as a system, helping us make everyday decisions and perform various tasks - from brushing our teeth to creating an end-of-the-year movie tier list. 

Inhibition of Inhibitory Control

Inhibition helps us control our thoughts and attention and focus on our choices, keeping us from falling prey to bad habits, impulses, and outside distractions. 

Yes, habits do steer the ship sometimes, and we can’t maintain composure against everything that happens to us.

But to give the credit where it's due, inhibition does work most of the time. If it didn’t, we wouldn’t be any different than cats, acting impulsively and wreaking havoc everywhere we go. 

Inhibitory control allows us to tune out irrelevant distractions like zoning in on our friend's words amid the chaos of a party. 

It also steps in when we must resist the itch to jump in before our friend finishes their thoughts. 

So, next time you see it, thank you to inhibitory control for keeping our focus sharp and our social grace intact.

Emotional Self-Regulation or Emotion Control

Strong emotions are completely normal and are perfectly fine. These feelings are inseparable parts of our day-to-day lives, from boiling anger and infectious excitement to nagging anxiety. 

Now, when those emotions hit hard, it’s crucial to experience them and understand them. We need to behave properly to not damage our connections with others. That’s when emotional self-regulation comes into play.

Picture emotional self-regulation as a close companion to inhibition. It’s the ability to process and manipulate our emotions (7). This skill goes beyond mental well-being—it's a key player in our physical health. As emotions can be very overpowering and physically taxing - causing increased heart rate or blood pressure - they can push us toward not-so-healthy coping strategies and make us perceive reality in a very distorted, emotionally charged way. 

Flexibility or Set Shifting

We love it when things are going according to our plans, but life is (un)fortunately unpredictable, and change is its constant companion. 

The real skill is navigating the twists and turns without breaking a sweat over the tiniest bumps on the road. Flexibility or set-shifting is the skill that lets us navigate this challenging part of our lives.

It’s an executive function that helps us change priorities, adapt to unexpected situations, and think outside the box. (3) Flexibility has a lot to do with creativity and being able to adjust our behavior when we face obstacles. 

This skill also comes in handy for seamlessly switching between tasks, zeroing in on what matters for our current goal, and staying focused. It’s a force that keeps us cool, creative, and on our toes.

Higher-Order Executive Functions

Some more sophisticated executive functions stem from the basic ones we just explored. 

Specifically, we're talking about the intricate domains of problem-solving, reasoning, time management, and planning. (5)

These high-level executive functions are the ones that enable us to set goals and plan the ways to reach them, use our memory to solve problems, reach logical conclusions, and make experience-based predictions. It's the high-level thinking that keeps our cognitive engine humming smoothly.

[What is Executive Dysfunction?] What is executive dysfunction?

When you read the previous section, did you have some kind of “Huh, that sounds like the things I struggle with” moments?

If you’re having trouble:

  • staying focused for a long time, 
  • memorizing new information
  • regulating your emotions
  • staying on schedule
  • have a knack for missing deadlines
  • struggle organizing activities
  • switching between tasks

…then congrats, you may be experiencing executive dysfunction! ADHDers frequently enjoy this fancy condition. 

Though executive dysfunction can sound like a standalone diagnosis, it’s not recognized as one. 

Think of it more as an indicator of other health conditions, not a condition alone.

A bit of a very nerdy and segue moment for those interested: 

Other parts of the brain are also involved in executive functioning. Сingulate cortex, parietal cortex, and subcortical structures like the basal ganglia, amygdala, and hippocampus - these brain areas work together when we engage in executive functioning. (6) Our brain is a beautiful and complicated system. We can talk for many hours about the fascinating ways this system functions, but let’s stay on task! 

Now, what causes executive dysfunction? Brain injuries and degenerative brain diseases, like dementia, are one of the primary origins. Problems with executive functioning can arise from other health conditions that affect our brain - multiple sclerosis, stroke, alcohol addiction, mental health disorders like schizophrenia, depression, obsessive-compulsive disorder, and some other health conditions (3).

[ADHD and Dysfunction Connection] What is the connection between executive dysfunction and ADHD?

While executive dysfunction can stem from various conditions, ADHD and executive dysfunction often go hand in hand. Though some lucky folks with ADHD may experience only mild symptoms of executive dysfunction, it is highly common among those who have this condition to struggle with executive functioning.

The partnership between ADHD and executive dysfunction is a spectrum of experiences that varies widely in how these conditions intersect and influence each other. For folks with ADHD, problems with inhibition can cause impulsivity, time-management and planning problems may lead to procrastination, and the lack of emotional self-regulation can spark emotional outbursts and meltdowns.

Folks with ADHD who suffer from executive dysfunction may also experience another unpleasant symptom some people call ADHD paralysis. This phenomenon can make even the simplest tasks feel insurmountable.

[Executive Dysfunction vs ADHD Paralysis] Executive dysfunction vs ADHD paralysis: what is it all about?

You probably have experienced something like that - when your brain just shuts down in a crucial moment, and you freeze for some time, unable to think straight. It’s another way executive functioning decides to act up for folks with ADHD.

For example, ADHD mental paralysis occurs when you've been caught in the whirlwind of sensory overload or swamped by emotions. Remember we talked about the bad things that can happen when emotional regulation is not working properly? That’s one of them right here.

Choice paralysis or “analysis paralysis” is an ADHD classic. It happens when you struggle to make a decision. You know, that feeling when picking the perfect option turns into a mental maze; you overthink everything and only make the situation worse because you are afraid to make any choice at all? *Cries in ADHD*

ADHD task paralysis happens when you’re not motivated enough to start doing some task, are scared of not getting it perfect right away, or don’t know where to start. So you just zone out. And when you get back to yourself one eternity later - surprise! The task is still miles away from being done. 

You may have experienced some other variations of these strange glitches. These are only the more common ones.

[What to do About ADHD Dysfunction?] What should you do if you struggle with executive dysfunction or experience ADHD paralysis?

Living with executive dysfunction can be quite a hurdle. It may inconvenience your everyday existence, slow your academic and career advancement, and even affect your relationships with others. And because of all this, you may feel inadequate and depressed. 

We don’t want you to feel bad about yourself, so the question arises: how do you deal with this? Oh, boy, I have some bad news for you… Just kidding, if you experience executive dysfunction as a part of your ADHD, it’s not a lost cause. 

For a start, some ADHD medications target executive dysfunction symptoms. So consider contacting your healthcare provider for professional medical consultation about the possible treatment you can receive.

Therapy is another great option for tackling life with executive function quirks. Cognitive behavioral therapy (CBT) is considered to be an effective method of treating some aspects of executive dysfunction(8). It may help you with emotion regulation and inhibition issues, as well as with planning and time management.

You can also find an executive functioning coach who will work with you regularly to determine the tools to help you best deal with your issues. Though hiring a personal coach can be quite pricey for many, it can be extremely helpful if you are struggling with your executive dysfunction.

There are also ways to ease the executive dysfunction symptoms without medications or therapy.

You can implement little tricks to deal with specific functions you have trouble with. For example, if you experience difficulties in planning and managing your time or if ADHD task paralysis has already become a part of your personality, you can use organizer apps and notifications on your smartphone that will help you to keep track of your tasks and work progress. You can find similar tips and guides for other issues you may grapple with online.

Physical exercise can also help. (No, this part wasn’t sponsored by some sportswear brand or gym network). 

It helps your brain(9), so consider incorporating movement into your life. It can also improve your overall well-being, which is a great bonus.

Executive dysfunction seems like a curse that doesn’t let you grow and succeed. Though it may be an overly dramatic way to look at things, it feels pretty accurate. But this curse is not impossible to lift. You just need a bit of help. Therapy, medications, and creative little tricks for planning and organizing can all make a difference. So, find the tools that will work best for you.

Sources

Handbook of Clinical Neurology. Executive Functions
Educational Psychology Review. Working Memory Underpins Cognitive Development, Learning, and Education
Handbook of Clinical Neurology. Executive Functions
American Academy of Neurology. Executive Dysfunction
American Academy of Neurology. Executive Dysfunction
Journal of Clinical Medicine. Higher-Level Executive Functions in Healthy Elderly and Mild Cognitive Impairment: A Systematic Review
Wiley Interdisciplinary Review. Educating Executive Function
Journal of Clinical Medicine. Executive Functions and Emotion Regulation in Attention-Deficit/Hyperactivity Disorder and Borderline Intellectual Disability
Archives of Clinical Neuropsychology. Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction
Scientific Reports. Acute Physical Activity Enhances Executive Functions in Children with ADHD
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